Monday, September 29, 2014

A reader writes:

I thought you would appreciate this overview of a study from the University of Utah on patient decision making when health care costs and outcomes are transparent. 
The authors studied the decisions made with regards to laparoscopic versus open appendectomy on pediatric patients when both cost (obviously higher w/ lap) and outcomes (similar w/ peds) were discussed upfront with the parents prior to surgery. Families chose open procedures almost twice as much as compared to the lap approach. 

This would become an even more interesting study to also include a third arm and similar transparent cost/outcomes discussions with da Vinci…that is, if only some hospital would be willing to participate. 

Indeed!  Here are excerpts from the article.

Consumer price comparison is almost nonexistent in the U.S. health care system, but a new study shows that when given the choice between a less costly “open” operation or a pricier laparoscopy for their children’s appendicitis, parents were almost twice as likely to choose the less expensive procedure – when they were aware of the cost difference. The study, published in the September issue of Annals of Surgery online, shows that providing pricing information upfront can influence patient choice of surgical procedures and potentially lead to cost savings in health care, a sector of the economy that accounts for more than 17 percent of the U.S. Gross Domestic Product, says Eric R. Scaife, M.D., senior author, associate professor of surgery and chief of pediatric surgery at the University of Utah (U of U) School of Medicine.

“Unlike other areas of the U.S. economy where it’s typical for people to compare prices before purchasing, health care consumers seldom know what they’ll pay for a procedure, meaning they have no basis for comparing costs,” Scaife says. “But our research found that when they have the information, consumers want to be in on health care decisions and that cost can influence what they choose when procedures are equally effective and have similar outcomes.”

Reasons for choosing the open operation varied among patients who received pricing information, including incision size, number of incisions, past experience and influence from a medical provider outside the surgical team. The most common reason, however, was cost: 31 percent of respondents said price was the primary influence on their choice of procedure.

“Cost-saving measures are important to me when it doesn’t impact the safety of the patient,” one respondent said.

The vast majority of respondents, 90 percent, said they liked having a choice in their health care, while only 3 percent would have preferred not to be given a choice. Lower median-income families were more likely to choose the open procedure than those of higher median incomes, but after accounting for the income difference, patients and parents exposed to the cost information still were 1.7 times more likely to choose the open procedure. Health insurance status appeared to play no role in the procedure choice.


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